Anxiety in Children

What is anxiety in children?

Anxiety and fear are a normal part of childhood. Fear is a natural reaction to danger or threat. Anxiety is a reaction to a possible threat. New fears and anxiety are usually short-lived and show that kids are learning to solve problems on their own. Parents and caregivers can help kids learn to understand and overcome their fears and anxieties.

Up to 1 in 5 kids will develop what healthcare providers consider anxiety disorders. Childhood anxiety disorders differ from normal fear or anxiety because they involve more extreme avoidance, bigger emotional reactions or last longer than expected. Children with anxiety disorders often have emotional outbursts like crying or tantrums. They may also show a lot of avoidance. They might try to escape, hide and be “on the lookout for danger” much of the time. In addition, kids often have body symptoms, like stomachaches, headaches, nausea, vomiting, shortness of breath or sleep issues.

What are the types of anxiety in children?

There are a few different types of anxiety in children:

• Separation anxiety disorder: Separation anxiety is a normal and important phase of early development that begins in most children when they’re 8 to 12 months old. With normal separation anxiety, your child may fear strangers and not feel safe when you’re not around. Separation anxiety usually gets better by the time kids enter preschool Separation anxiety disorder is more extreme and continues beyond this typical developmental period. Kids may be worried about parents or other family members and have difficulty going to school or being away from home or family generally, or may have difficulty separating for sleep. If your child shows extreme distress or worry with separations than other kids their age, you don’t see improvements or have concerns, talk with your child’s healthcare provider.
• Specific phobias: Fear protects us from danger, so a certain amount of fear in kids is expected. Your child might be scared about something in particular, like storms or clowns or any variety of things. But specific phobias are extreme fears that are out of proportion with the actual threat of danger.
• Social anxiety disorder: This is an intense fear of being judged or rejected in social situations. Your child might avoid public speaking or performing. Or they might be so uncomfortable that they try to avoid interacting with others at school or other familiar settings or have a hard time speaking to new people. They may even avoid social situations altogether.
• Generalized anxiety disorder: Generalized anxiety is excessive worry and fear about a range of different things that happen in daily life. Your child may also worry about the future more than other children their age. They may have many worries or worries may change over time, but they’re often worried about something.
• Panic disorder: Children with panic disorder have times when they feel extreme fear and anxiety along with physical symptoms like a racing heart (heart palpitations) and dizziness or they might feel like they can’t breathe (dyspnea). These panic attacks can come on without warning and tend to go away within minutes to hours.

How common is anxiety in children?

Anxiety disorders are fairly common in children. They affect about 15% to 20% of children and adolescents. And nearly 1 in 3 adolescents between the ages of 13 and 18 has anxiety. It’s also more common in people assigned female at birth.

What are the signs and symptoms of anxiety in children?

Parenting can feel like a guessing game. Some children will use words to tell you about their anxiety. They might say something like: “I’m afraid to go to school because I’m worried I’ll never see you again.” Others might not know how to explain their feelings. But children also show signs of anxiety. They may:

• Worry and/or cry more than other kids their age.
• Say they don’t feel well. They might complain of an upset stomach, sore muscles or headache.
• Have trouble sleeping, wake from nightmares or be unable to sleep alone.
• Find it hard to relax or sit still (restless).
• Anger easily.
• Have a hard time focusing.
• Say they aren’t hungry, or that they’re hungry all the time.
• Shake (tremor).
• Refuse to go to school.
• Use the bathroom a lot.

What causes anxiety in children?

Some kids are naturally sensitive and may have a hard time coping with change or strong emotions. These kids may have a biological or family tendency to be anxious. Anxiousness can also develop after stressful life events, and some people have many stressful events from a very early age, like:

• The death of someone close to them.
• Moving to a new house or school, especially if those moves are frequent.
• Difficulty with getting enough to eat.
• Difficulty with safe places to live.
• Difficulty with consistent schooling.
• Parents who fight or argue, or separation and divorce.
• Bullying, abuse or neglect.

What is the main cause of anxiety in children? 

It’s hard to say for sure what the main cause of childhood anxiety is. Fear is a natural part of growing up. Some kids manage it OK. But for children with anxiety that interferes with their day-to-day lives, it’s thought that genetics, biology and family history play roles.

What are the complications of this condition?

Children with anxiety are at increased risk for depression and substance use disorders later in life. They may struggle in school or with attending school. They’re also at higher risk for suicide. Although these are scary, it’s important to remember that treatments are available. Be sure to follow up with your child’s healthcare provider as often as they recommend. And seek immediate medical attention or call the Suicide and Crisis Lifeline at 988 (in the United States) if you think your child might hurt themselves.

How is anxiety in children diagnosed?

To diagnose anxiety in your child, their healthcare provider will talk with both you and your child. They’ll ask you about your child’s behavior and how you can tell they’re anxious. They’ll ask your child to tell them about any symptoms they notice and when they notice them. They may ask you to complete surveys. They may also want to talk to your child’s teacher or other caregivers for more information about your child’s symptoms. They’ll look for other causes of your child’s symptoms. Your child may be diagnosed with an anxiety disorder if there’s no other cause for their symptoms and their anxiety causes distress and has interfered with their life for six months.

How is anxiety in children treated?

There are two main ways to treat anxiety in children: cognitive behavioral therapy and medication therapy. Both of these treatments may work on their own, but they seem to work better together.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps children learn coping skills that help with calming body reactions, thinking differently and facing fears and challenges in smaller steps. Children can learn coping skills in individual therapy or group therapies. Parents can also learn about these coping skills so they can support their children in practicing them.

Medications

Your child’s healthcare provider may prescribe a selective serotonin reuptake inhibitor (SSRI) like:

• Fluoxetine (Prozac®). 
• Paroxetine (Paxil®, Pexeva®). 
• Sertraline (Zoloft®).

Or if these aren’t effective or appropriate for your child, they may prescribe a serotonin and norepinephrine reuptake inhibitor (SNRI) like:

• Duloxetine (Cymbalata®, Drizalma®, Irenka®).

Side effects of medications that treat childhood anxiety

Call your healthcare provider if your child develops any of the following side effects:

• Allergic reaction.
• Bloody poop.
• Fast or irregular heartbeat.
• Fainting, dizziness, chest pain or shortness of breath.
• High fever.
• Sudden vision changes or eye pain.
• Thoughts of suicide or worsening mood.

There are other side effects from medications used to treat anxiety in children that don’t normally require medical attention. They should go away after a few weeks but may come back if your child’s dose changes. Your child’s healthcare provider will discuss all this information with you and answer your questions.

• Appetite changes.
• Difficulty sleeping or drowsiness.
• Dry mouth. 
• Headache.
• Shaking (tremors).
• Upset stomach, nausea or diarrhea.

How soon after treatment will my child feel better?

Many families begin with CBT and add additional therapies if needed. CBT, either individually — with a parent as co-therapist — or in groups, can be very effective in teaching step-by-step coping skills that reduce symptoms and improve coping. Because this type of therapy involves learning, children often learn quickly and can feel better and more confident within a few sessions. Sometimes, sessions reduce some symptoms but more help is needed for kids to be able to conquer their anxiety. In these situations, medication is also important.

Medications like SSRIs and SNRIs can take some time to start working. And not every medication works the same way in every person. Your child’s healthcare provider may try one medication for a period of time (usually at least several weeks to a few months) to see if it helps. If it doesn’t help, they may try a different medication.

What can I expect if my child has anxiety?

If your child has an anxiety disorder, they may act out or be irritable. They may cling to you or refuse to leave the house. Although treatment for childhood anxiety can take time to work, it generally reduces symptoms. With treatment, many children with anxiety participate in activities that interest them, form friendships, finish school and enjoy life.

There may be periods in your child’s life when their anxiety starts to overwhelm them again. When this happens, they may need adjustments to their medications or more frequent therapy sessions until their anxiety symptoms are better managed. 

What helps with childhood anxiety? 

As a parent or caregiver, you can’t always manage the stressors in your child’s life. But you can help improve their mental health by ensuring they get:

• Daily exercise.
• A safe, supportive environment at home and school.
• Plenty of sleep.
• Well-balanced meals.

You can also teach your child meditation techniques and breathing exercises to help them relax. You might encourage your child to take small steps to overcome normal worries and fears, too, like entering a social setting while you wait a few feet away, or turning off the lights for a few minutes and trying to relax. This helps kids develop confidence and coping skills.

When should I call a healthcare provider about my child’s anxiety?

You should call your healthcare provider if your child shows signs of anxiety that don’t go away, or they stop doing things you know they can do (like use the toilet or leave the house).

If your child shows signs of suicide, get help right away. You can call the Suicide and Crisis Lifeline at 988 (in the United States). This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, seven days a week. In an emergency, call 911.